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Right Decision Service newsletter: April 2024

Welcome to the Right Decision Service (RDS) newsletter for April 2024.

Issues with RDS and Umbraco access

Tactuum has been working hard to address the issues experienced during the last week. They have identified a series of three mitigation measures and put the first of these in place on Friday 3^rd May. If this does not resolve the problems, the second mitigation will be actioned, and then the third if necessary.

Please keep a lookout for any slowing down of the system or getting locked out. Please email myself, mbuchner@tactuum.com and onivarova@tactuum.com if you experience any problems, and also please raise an urgent support ticket via the Support Portal.

Thank you for your patience and understanding while we achieve a full resolution.

Promotion and communication resources

A rotating carousel presenting some of the key RDS tools and capabilities, and an editable slideset, are now available in the Resources for RDS providers section of the Learning and Support toolkit.

Redesign and improvements to RDS

The redesign of RDS Search and Browse is still on-track for delivery by mid-June 2024. We then plan to have a 3-week user acceptance testing phase before release to live. All editors and toolkit owners on this mailing list will be invited to participate in the UAT.

The archiving and version control functionality is also progressing well and we will advise on timescales for user acceptance testing shortly.

Tactuum is also progressing with the deep linking to individual toolkits within the mobile RDS app. There are several unknowns around the time and effort required for this work, which will only become clear as the work progresses. So we need to be careful to protect budget for this purpose.

New feature requests

These have all been compiled and effort estimated. Once the redesign work is complete, these will be prioritised in line with the remaining budget. We expect this to take place around late June.

Evaluation

Many thanks to those of you completed the value and impact survey we distributed in February. Here are some key findings from the 65 responses we received.

Figure 1: Impact of RDS on direct delivery of care

Key figures

93% say that RDS has improved evidence-informed practice (high impact 62%; some impact 31%)
91% report that RDS has improved consistency in practice (high impact 65%, some impact 26%)
85% say that RDS has improved patient safety (high impact 59%, some impact 26%)
Although shared decision-making tools are only a recent addition to RDS, and only represent a small proportion of the current toolset, 85% of respondents still said that RDS had delivered impact in this area (53% high impact, 32% some impact.) 92% anticipate that RDS will deliver impact on shared decision-making in future and 85% believe it will improve delivery of personalised care in future.

Figure 2 shows RDS impact to date on delivery of health and care services

Key figures

These data show how RDS is already contributing to NHS reform priorities and supporting delivery of more sustainable care.

Saving time and money

RDS clearly has a strong impact on saving practitioner time, with 90% of respondents reporting that this is the case. 65% say it has a high impact; 25% say it has some impact on time-saving.
It supports devolved decision-making across the multi-professional team (85% of respondents)
76% of respondents confirm that it saves money compared, for example, to investing in commercial apps (54% high impact; 22% some impact.)
72% believe it has impacted already on saving money and reducing waste in the way services are delivered – e.g. reducing costs of referral management, prescribing, admissions.

Quality assurance and governance

RDS leads are clear that RDS has improved local governance of guidelines, with 87% confirming that this is the case. (62% high impact; 25% some impact.)

Service innovation and workforce development

RDS is a major driver for service innovation and improvement (83% of respondents) and has impacted significantly on workforce knowledge and skills (92% of respondents – 66% high impact; 26% some impact).

New toolkits

A few examples of toolkits published to live in the last month:

Acute oncology guidelines (NHS Lothian. Password protected. Please contact decisionsupport@nhs.scot if you would like to be put in touch with the toolkit owner to request the password.)
SPEG (Scottish Paediatric Endocrine Group)
Patient Information Leaflets (NHS Borders)
Respiratory prescribing – national guidance from Scottish Government Effective Prescribing and Therapeutics Division.

Toolkits in development

Some of the toolkits the RDS team is currently working on:

SARCS (Sexual Assault Response Coordination Service)
Staffing method framework – Care Inspectorate.
SIGN 171 - Diabetes in pregnancy
SIGN 158 – British Guideline on Management of Asthma. Selected sections will be incorporated into the RDS, and complemented by a new chronic asthma pathway being developed by SIGN, British Thoracic Society and NICE.
Clinical pathways from NHS Fife and NHS Lanarkshire

Please contact his.decisionsupport@nhs.scot if you would like to learn more about a toolkit. The RDS team will put you in touch with the relevant toolkit lead.

Quality audit of RDS toolkits

Thanks to all of you who have responded to the retrospective quality audit survey and to the follow up questions. We still have some following up to do, and to work with owners of a further 23 toolkits to complete responses. An interim report is being presented to the HIS Quality and Performance Committee.

Implementation projects

Eight clinical services and two public library services are undertaking tests of change to implement the Being a partner in my care app. This app aims to support patients and the public to become active participants in Realistic Medicine. It has a strong focus on personalised, person-centred care and a library of shared decision aids, as well as simple explanations and videoclips to help the public to understand the aims of Realistic Medicine. The tests of change will inform guidance and an implementation model around wider adoption and spread of the app.

With kind regards

Right Decision Service team

Healthcare Improvement Scotland

PARACETAMOL

Important: Therapy notes

MHRA advice: Intravenous paracetamol (Perfalgan▼): risk of accidental overdose (December 2014) (www.gov.uk)

Risk Minimisation Materials: paracetamol 10mg/mL solution for infusion training poster

Paracetamol caplets may be easier to swallow than standard tablets and are preferred by many patients. Caplets may be supplied on a prescription for paracetamol tablets.
The salt content of dispersible formulations of paracetamol and co-codamol may be unsuitable for some patients.

Important: Formulation and dosage details

Formulation:

Tablets^OTC500mg

Dosage:

Adults 50kg and over: 1 gram up to 4 times daily.
Consider dose reduction in patients with low body weight (less than 50kg), renal/hepatic impairment, chronic malnutrition, or chronic alcoholism to 15mg/kg/dose up to 4 times daily (to a maximum of 3 grams/day)

Important: Formulation and dosage details

Formulation:

Soluble tablets^OTC 500mg

Dosage:

Adults 50kg and over: 1 gram up to 4 times daily.
Consider dose reduction in patients with low body weight (less than 50kg), renal/hepatic impairment, chronic malnutrition, or chronic alcoholism to 15mg/kg/dose up to 4 times daily (to a maximum of 3 grams/day)

Important: Formulation and dosage details

Formulation:

Oral suspension^OTC120mg/5mL, 250mg/5mL

Dosage:

Adults 50kg and over: 1 gram up to 4 times daily.
Consider dose reduction in patients with low body weight (less than 50kg), renal/hepatic impairment, chronic malnutrition, or chronic alcoholism to 15mg/kg/dose up to 4 times daily (to a maximum of 3 grams/day)

Important: Formulation and dosage details

Formulation:

Suppositories^OTC 60mg, 120mg, 240mg, 500mg

Dosage:

Adults 50kg and over: 1 gram up to 4 times daily.
Consider dose reduction in patients with low body weight (less than 50kg), renal/hepatic impairment, chronic malnutrition, or chronic alcoholism to 15mg/kg/dose up to 4 times daily (to a maximum of 3 grams/day)

Important: Formulation and dosage details

Formulation:

Intravenous infusion 500mg/50mL, 1 gram/100mL

Dosage:

Adults 50kg and over: 1 gram up to 4 times daily.
Consider dose reduction in patients with low body weight (less than 50kg), renal/hepatic impairment, chronic malnutrition, or chronic alcoholism to 15mg/kg/dose up to 4 times daily (to a maximum of 3 grams/day)

Notes:

Note: Paracetamol infusion:

Is 100% bioavailable and there is a greater risk of toxicity so should only be prescribed where clinically indicated. Review the prescription regularly.
Should only be used when the patient is ‘nil by mouth’, or has swallowing difficulty which is not overcome by the use of suspension.
Must be given in lower doses to patients under 50kg.
Maximum daily dose must not exceed 3 grams in patient with renal/hepatic impairment, chronic malnutrition, chronic alcoholism.
Increase the minimum interval between each dose to 6 hours if creatinine clearance is less than 30mL/min.
Is more effective than paracetamol suppositories.

NEFOPAM

Important: Therapy notes

Can cause sympathomimetic and anticholinergic side-effects and is increasingly expensive.

Important: Formulation and dosage details

Formulation:

Tablets 30mg (specialist initiation/recommendation only)

Dosage:

By mouth, in patients with renal impairment as an alternative to opioids and NSAIDs, start at 30mg up to 3 times daily.